The reasoning I've heard is that the interactions between the water additives in community water sources, and medications, are not well studied. Safest therefore to use sterile water which is, in theory, JUST water.

I take this with a grain of salt because what about people who just drink liquid meds with tap water? Or what about the substances leaching out of the plastic bottles? But yeah if your tap water is brown then I'd go sterile too [emoji15]

Hi, working with a home health agency now. We have CNAs, but they are currently waaay underutilized. I know there are ways to keep CNAs busy & cost-effective in home health, but I suspect we have multiple issues, including:

1) Ignorance on the part of our parent organization about the referral process and what we can offer

2) Ignorance on our part about how we can get help from our CNAs and still have the visit be billable for Medicare.

Does anyone have any ideas about how we can get our CNAs in homes and billable, or how they can help reduce costs around here? Right now they're often sweeping floors and stocking our supplies, and they miss helping actual people.

I've had hand burns, small but open during work shifts. I found that a single Tegaderm stuck ok until I needed to, oh, say, sanitize or wash my hands.

Solution? Goopy skin adhesive, the kind we use to make NG tube securing devices stick to the nose. Then multiple Tegaderms formed into a kind of bionic half-glove. Even that would melt off or get wet about 4x per shift, but the wound stayed protected. Not sure how it worked from an effective hand cleansing point of view, though. I mean, it stayed on ok but did the dressing really ever get clean?

Side note: as a person with low thyroid hormone which Synthroid replaces, I wake myself up one hour early to take that med even after working a 14 hour day the day before and heading in to another one. Food drastically decreases that med's effectiveness, and life with low thyroid hormone = feeling like a cranky, depressed, slug with mono. If a patient refuses to be woken up in time to take the meds inactivated by food AND they're mentally competent to make their own decisions, I'll respect that....and inform their doctor, who might want to know.

LTC staffing & timing often makes "extra" med passes such as those before meals hard on everyone, residents and staff alike.

A very experienced ED nurse told me that if IV metoprolol is pushed too fast, it can "bottom out" a patient's pressures, making them ineligible to get other meds they might really need for heart rate irregularities/MI.

In the ICU, maybe this would translate to unnecessary pressor boluses?

I don't know what to do. Need any of the following: encouragement, empathy, inspiration, similar stories, suggestions. Even tough love though I reserve the right to say ouch.

I'm 1.5 years into med-surg. 5 patients, but often some of them step down type acuities (our hospital doesn't have a step-down unit). Also, often, only 1 CNA for our 25 bed unit which has up to 7 or 8 total care patients with maybe also a few active CIWA patients and of course the bone fracture patients with dementia who are set on walking home on their non weight bearing limb. No med clerk. No lunch or any other kind of breaks. Yes, am aware some of y'all dream about having even these working conditions! You're entitled to vent too, even more than me! And...maybe your own thread?

Night shift, which doesn't help me. Not a night person. Plus recently dx'ed with a metabolic disorder which drains my energy and makes me more prone to brain fog and fatigue, ESPECIALLY in metabolically subprime hours like night. Taking meds for it. Are they working yet?????

Pro's: work with some very good nurses that I respect a lot. Everyone helps, some more enthusiastically in some ways than others but all have strengths. I can't ask the elder stateswoman with a bad back for help with a turn but she will give me great advice on adjusting care for condition, what to suggest to the MD. Overt bullying is low to almost nonexistent.

Nursing superpowers: recognizing changes in condition. Passionate about safe pain management. Thorough assessments. Compassion. My CNA last week said that patients keep asking her, "Is Cinquefoil going to be my nurse again tonight?" when she rounds at start of shift. Ninja at convincing the paranoid schitzophrenic patients that they need their antibiotics, or can stop freaking out now. Education using plain, approachable language. Listening. Handwashing. I will always help other nurses with whatever. Or CNAs. My patients tend to wear their SCD's. I take them on walks. I've been known to give backrubs. I've kept CIWA patients with initial scores of 23 "off the unit" and safely recovered.

I floated, as a new grad. Got good feedback from the floors I was on. They always asked to have me back. I enjoyed it.

Kryptonites: Charting. I never feel good about putting patient care off for charting. The doctors never read what we chart, only the lawyers and insurance people. I would love to chart in rooms but we are never adequately staffed with call light/bed alarm answering people to allow this. Am either doing THINGS or out at nurse's station, trying to chart while always interrupted.

I suck at charting interrupted. When I do chart I like to do it thoroughly. Not doing that lately.

Always charting late. Get a subtle stink-eye from next shift about it, indulgent smiling eye roll type behavior from my own shift. "Oh, that Cinquefoil!" I am a manager's nightmare of overtime.

I suck at saying no. Yes to warm blanket. Yes to fixing how your legs are. Yes to the new admit along with my 2 total cares and 2 nutcases, all of whom I perversely connect well with, one of whom needs to go down to CT. Yeah, I know. GET BETTER AT SAYING NO AND STICKING UP FOR MYSELF! Getting better. Apparently not fast enough.

Getting better at: helping patients set realistic expectations.

But what I really suck at is making progress at these growth areas when I'm tired, hungry, brain-foggy, with a constant nagging inner voice saying "This is typical! You got yourself in a hole again! Why are you still running around when everyone else is already charting! Can't you suck LESS for a change??"

Home life: marriage pretty rocky in the last year, in couples counseling. Making things better, but will it make them good, again, ever??? In time to have babies at my late age?? Several deaths in the immediate family just when I'd moved far away, fewer jobs for husband near family, stress of last move was not good for our relationship. New town, miss my friends. Tired all the time. A few good new friends, weekly family phone calls, the great outdoors, and the love of one good dog - plus reality TV shows and the library - keep me going.

I finally made it past minimum wage to "the good life" and I do feel I'm supposed to be a nurse. I love MANY aspects of this job - the physicality and intimacy of direct care, the teamwork, the complexity of pathophys, the always learning new things, the pride of a good IV start or of helping a patient get better or die well. But when does life start to get good, and what kind of nurse am I supposed to be?

Is there another kind of nursing that will play to my strengths and downplay my weaknesses? Or do I just need lunch breaks, better staffing, and a full night's sleep? Or???

Am already trying: counseling, brain sheets (revised over and over), asking other nurses for feedback, asking manager and unit educator for advice. Am cruising for a burnout and wish I knew how to turn it around.

If your behavior was out of character, then bravo. And if you can laugh at and forgive yourself for those few less than ideal moments, the basic drives that keep you compassionate and present will be more free to do what they do naturally.

This question is exactly why my hospital has a clear policy stating that when vancomycin is given, the pharmacist will decide if the vancomycin should be given or held while the trough value is being processed. Then, whatever they decide goes into the vanco order set.

Because....I'm not a pharmacist!

Sure, I know vanco can be nephrotoxic, and can cause Red Man Syndrome, and is very painful when extravasated. And I can look up more, very quickly. But I do not have the depth and nuance of knowledge a pharmacist has.

There are sterile flushes and non-sterile flushes. Sterile flushes will be labeled as sterile instead of the regular ones which will just be labelled "sterile barrel" or such. Sterile flushes can be placed on a sterile field; "partially sterile" ones such as those usually used are only sterile under the cap at the tip and inside to where the plunger originally meets the liquid. These may not be used on a sterile field.

If medications are diluted within "partially sterile" flushes using aseptic technique, they do stand a risk of being contaminated, especially if the flush plunger is pulled back farther than the original fluid fill point or if there are germs on the outside of the plunger at any time due to aseptic technique's lack of sterility.

In addition, if we do dilute by any method, we should always follow an evidence-based guide and pharmacy policy on which meds to dilute in what.

Is this a fair summary?

You raised a GREAT question. Made me look closer at labels on everything in my workplace, at my practice, and at my facility's practice. Please keep asking!